Marks Jonathan H
Director of the Bioethics Program at the Pennsylvania State University, and Affiliate Faculty in Law, Philosophy, Public Policy, and International Affairs. The author is also a barrister and academic member of Matrix Chambers, London and Geneva. He is extremely grateful to Michele Mekel, Marc Rodwin, and Sunita Sah for comments on an earlier draft. Please excuse any errors or omissions-final revisions to this piece were made during the COVID-19 pandemic.
Am J Law Med. 2020 May;46(2-3):275-296. doi: 10.1177/0098858820933499.
Corporate influence is one of the most pressing issues in public health. It cuts across many of our most intractable problems-from obesity to the opioid epidemic. Companies develop close relationships with public health agencies, research universities, academic medical centers, professional societies, and patient advocacy organizations-often funding medical research and public health interventions intended to address the very challenges these corporations are creating or exacerbating. How we view relationships with industry, including how these relationships are framed in ethical discourse, shapes our legal and policy responses to them. In recent years, fueled in part by the opioid epidemic, the ethical framing of industry relationships has begun to evolve in significant ways. But legal and policy responses have not yet caught up. In this article, I develop a temporal account of corporate influence, and legal and policy responses to corporate influence. This account clarifies the limitations and adverse effects of conflicts of interest disclosure, especially when implemented as the sole legal or policy response. Disclosure can illuminate corporate influence-but policymakers cannot and should not rely on disclosure to eliminate corporate influence or its effects. Nor should we allow disclosure to crowd out structural and systemic responses to corporate influence-including sequestration of and separation from private-sector entities.
企业影响是公共卫生领域最紧迫的问题之一。它贯穿于我们许多最棘手的问题之中——从肥胖到阿片类药物流行。企业与公共卫生机构、研究型大学、学术医疗中心、专业协会和患者倡导组织建立密切关系——通常为旨在应对这些企业正在制造或加剧的挑战的医学研究和公共卫生干预措施提供资金。我们如何看待与行业的关系，包括这些关系在伦理话语中的构建方式，塑造了我们对它们的法律和政策回应。近年来，部分受阿片类药物流行的推动，行业关系的伦理框架已开始以重大方式演变。但法律和政策回应尚未跟上。在本文中，我阐述了企业影响的时间脉络，以及对企业影响的法律和政策回应。这一阐述阐明了利益冲突披露的局限性和不利影响，尤其是当它作为唯一的法律或政策回应实施时。披露可以揭示企业影响——但政策制定者不能也不应依赖披露来消除企业影响或其后果。我们也不应允许披露排挤对企业影响的结构性和系统性回应——包括隔离和脱离私营部门实体。
